Tissue graft fixation

ABSTRACT

A surgical device includes a member having first and second opposing surfaces. The member includes an intermediate portion in which the first surface has a recessed surface portion. The intermediate portion defines a hole extending from the recessed surface portion to the second surface. End portions extend from the intermediate portion, and each end portion defines a hole extending from the first surface to the second surface. The member has a tapered surface portion on the second surface. The surgical device includes a second member sized to be received within the recessed surface portion. A method includes locating a tissue fixation device at an opening to a bone hole, and increasing the size of the tissue fixation device by placing the tissue fixation device within a larger device.

TECHNICAL FIELD

This invention relates to tissue graft fixation.

BACKGROUND

An anterior cruciate ligament (ACL) that has ruptured and isnon-repairable is generally replaced arthroscopically by a tissue graft.The tissue graft can be harvested from a portion of a patellar tendonhaving so called “bone blocks” at each end, and from the semitendonosisand gracilis. Alternatively, the tissue graft can be formed fromsynthetic materials or from a combination of synthetic and naturalmaterials.

The replacement tissue graft is implanted by securing one end of thetissue graft in a socket formed in a passage within the femur, andpassing the other end of the graft through a passage formed in thetibia. Generally, sutures are used to affix each end of the tissue graftto a fastener (e.g., an interference screw or a post), which is thensecured to the bone.

It is also known to use a graft fixation member, e.g., a fixationbutton, to secure the tissue graft at the femoral cortex, as describedin U.S. Pat. No. 5,306,301 (“the '301 patent”) hereby incorporated byreference in its entirety. When using a fixation button, the femoralpassage generally includes a relatively larger diameter portion forreceiving the graft, and a smaller diameter, passing channel near thefemoral cortex for receiving a length of suture that runs from thetissue graft to the fixation button. By measuring the total length ofthe femoral passage and the length of the larger diameter portion of thefemoral passage, the surgeon determines the appropriate length of suturematerial for attaching the fixation button to the tissue graft.

SUMMARY

According to one aspect, a surgical device includes a member havingfirst and second opposing surfaces. The member includes an intermediateportion in which the first surface has a recessed surface portion. Theintermediate portion defines a hole extending from the recessed surfaceportion to the second surface. End portions extend from the intermediateportion, and each end portion defines a hole extending from the firstsurface to the second surface.

Embodiments of this aspect may include one or more of the followingfeatures.

The surgical device includes a second member sized to be received withinthe recessed surface portion. The intermediate portion defines twoadditional holes extending from the recessed surface portion to thesecond surface. The member has a tapered surface portion on the secondsurface. The intermediate portion hole is elongated.

According to another aspect, a surgical device includes first and secondmembers. The first member has first and second opposing surfaces, arecessed surface portion in the first surface, and a hole extending fromthe recessed surface portion to the second surface. The second memberdefines a hole and is configured to be received within the recessedportion of the first member.

Embodiments of this aspect may include one or more of the followingfeatures.

The holes are positioned to be axially aligned when the second member isreceived within the recessed portion. The recessed portion is configuredto provide a snap-fit or an interference-fit with the second member. Thesurgical device includes a suture extending through the holes. The firstmember defines at least two additional holes, for example, a total offive holes. The second member defines three additional holes. The firstmember has a tapered surface portion on the second surface of themember.

According to another aspect, a method includes locating a tissuefixation device at an opening to a bone hole, the tissue fixation devicebeing coupled to a tissue graft by a flexible member, for example,suture, and increasing the size of the tissue fixation device by placingthe tissue fixation device within a larger device having a hole forreceiving the flexible member. This aspect may include increasing thesize of the tissue fixation device prior to locating the tissue fixationdevice at the opening.

Advantages may include one or more of the following: the continuation ofan endoscopic procedure despite perforation of the cortex; use withoutside in femoral drilling as is done in pediatric cases to avoidcrossing the epiphysis; use as a fast primary to avoid the need forusing two drills and measuring of the EndoButton CL length; and coverageof a 6-10 mm tunnel.

The details of one or more embodiments of the invention are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the invention will be apparent from thedescription and drawings, and from the claims.

DESCRIPTION OF DRAWINGS

FIG. 1 is an illustration of a tissue graft secured within the knee by agraft fixation member.

FIG. 2A is an exploded, perspective view of the graft fixation member ofFIG. 1.

FIG. 2B is a end view of the graft fixation member of FIG. 1.

FIG. 3A is an end view of a washer of the graft fixation member of FIG.1.

FIG. 3B is a side view of the washer of FIG. 3A.

FIG. 4A is a perspective view of the graft fixation member of FIG. 1shown threaded with suture.

FIG. 4B is an illustration of the graft fixation member coupled to atissue graft, with the washer shown in dashed line.

FIG. 5 illustrates drilling a femoral passage within a knee.

FIG. 6 shows engagement of the graft fixation member with a sutureretrieval device for pulling the graft fixation member through thefemoral passage.

FIG. 7A is perspective view of a washer according to another embodiment.

FIG. 7B is a side view of the washer of FIG. 7A.

FIG. 7C is a sectional view taken along line 7C-7C in FIG. 7B.

FIG. 8 is a side view of a washer according to another embodiment.

FIG. 9 is a side view of a washer according to another embodiment.

FIG. 10A is perspective view of a washer according to anotherembodiment.

FIG. 10B is an end view of the washer of FIG. 10A.

FIG. 10C is a sectional view taken along line 10C-10C in FIG. 10B.

DETAILED DESCRIPTION

Referring to FIG. 1, a fixation member 90 connected to a bone block 22of a tissue graft 20 by suture 30 is positioned over the opening 17 of afemoral passage 14 to secure the graft 20 in the femoral passage 14.Fixation member 90 includes a second member, e.g., a button 100,received within a first member, e.g., a washer 110. In contrast totechniques that include drilling a passing channel in the femur, such asdescribed in the '301 patent, fixation member 90 enables femoral passage14 to have a substantially uniform diameter, thus eliminating the addedsteps of measuring and drilling the relatively smaller passing channel.

Referring to FIGS. 2A-3B, the washer 110 has a generally elongate shapewith an intermediate portion 111 and end portions 112 extending from theintermediate portion 111. Washer 110 has first and second opposingsurfaces 114, 115, and the intermediate portion 111 has a recessedsurface portion 116 for receiving button 100. Intermediate portion 111has a hole 120, preferably centrally located, extending from therecessed surface portion 116 to the second surface 115 for receiving thegraft tissue suture 30. The washer 110 defines four additional holes125, one hole 125 b in each of the end portions 112, and two inner holes125 a in intermediate portion 111 on either side of central hole 120,for receiving a pull suture 45 (FIG. 4). Holes 125 extend from the firstsurface 114 to the second surface 115 of the washer.

The washer surface 115 is tapered from end portions 112 to intermediateportion 111 (such as shown in FIG. 7C), and can also be tapered alongthe entire distance between end portions 112 and the intermediateportion 111 as shown in FIGS. 7C and 10C. It is the intermediate portion111 of the washer that is received within the opening 17 of the femoralpassage 14 during use with the washer surface 115 facing the femoralpassage. The taper permits fixation member 90 to securely engage theopening 17 of the femoral passage 14 with the washer end portions 112against the bone 20 surface, while maintaining a low profile relative tobone surface. The taper facilitates a tight fit between the fixationmember 90 and passage openings 17 having a range of diameters. Thus, thetapered reduces the need to precisely match the size of the graftfixation member with the femoral passage opening. However, the washerneed not include the tapered portion.

The button 100 defines holes 105, four holes being shown. The twocentral holes 105 a align with the washer central hole 120, and the twoend holes 105 b each align with one of the inner washer holes 125 a whenthe button 100 is positioned within the washer recess 116. The elongatedwasher 110 has a length L, a width W and a thickness T, for example, foran adult femur, the washer 110 has a length of about 15-30 mm, forexample, 20 mm, a width of about 6-10 mm, for example, 6 mm, and athickness of about 1-4 mm, for example, 3 mm, to bridge the span of afemoral passage 14 and provide sufficient rigidity to adequately tensionsutures holding a tissue graft 20 while maintaining a relatively lowprofile with respect to the surface of the femur 12. The washer recess116 is dimensioned to receive the button 100 by, for example, a snap-fitor interference-fit, and has a depth corresponding to the thickness ofthe button such that the button is flush with the surface 114 of thewasher 110.

Referring to FIGS. 4A and 4B, the button 100/washer 110 combination isprovided with two closed loops of suture 30 extending through washerhole 120 and threaded through button holes 105 a. Graft fixation member90 is also provided with one suture 45 threaded through one of thewasher holes 125 b, back through the adjacent washer hole 125 a, andthrough the corresponding button hole 105 b, and a second suture 45similarly threaded through the holes on the other side of the washer andbutton. Alternatively, operating room personnel can thread the sutures45. FIG. 6 shows an alternative threading of sutures 45, with one suture45 threaded through each of the washer holes 125 b. Here, washer holes125 a and button holes 105 b are not used.

Referring to FIGS. 5 and 6, in use, a femoral hole 17 of substantiallyuniform diameter is drilled using a drill 40. To pull the graft fixationmember 90 and tissue graft 20 through the tibia and femur passages, asuture retrieving device, such as a passing pin 50, is used to removablyengage the free ends of sutures 44 and pull the fixation member 90through the knee 10.

Referring to FIG. 1, once the fixation member 90 has been pulled throughthe femoral passage 14, the surgeon positions the fixation member 90transversely to the femoral passage 14 and across the opening 17. Tocomplete the fixation of the tissue graft, the fixation member 90 issecured against the femur 12 by attaching the tissue graft 20 to thetibia 13 and tensioning the tissue graft 20 and the closed-loop suture30 according to methods described in the '301 patent.

Other embodiments are within the scope of the following claims. Forexample, other embodiments can include washers appropriately sized andshaped to receive buttons with a variety of geometries. Referring toFIGS. 7A-7C, rather than including both the central hole 120 and sutureholes 125 a within the recess 116, a washer 710 includes only a centralhole 720 within a recess 716 sized and shaped to accommodate suture fromthe four holes 105 a and 105 b of the button. Hole 720 includes two sideextending openings 722, 724 for receiving suture from holes 105 b. Thewasher 710 includes suture holes 725 b in end portions 712 of the washer710.

Referring to FIG. 8, in another embodiment, a washer 810 includes onlyan elongated, central hole 820 within a recess 816, and side holes 825B.Referring to FIG. 9, in another embodiment, a washer 910 includes acentral hole 920 and side holes 925B, analogous to holes 720 and 725 bin washer 710, but additionally includes holes 925 a. In anotherembodiment (FIGS. 10A-10C), a washer 1010 includes round suture holes1025 b in end portions 912, and oblong suture holes 1025 at recessportion 1016 adjacent to a central hole 1020.

Although the aforementioned embodiments have been described inconnection with procedures having a single, uniformly-sized femoralpassage, the graft fixation member can be applied to procedures in whicha smaller passing channel is formed in the femoral passage. For example,the creation of a smaller passing channel may be desirable in somepatients, such as child whose bones are growing or an elderly patientwithout sufficient bone density to accommodate a relatively largefemoral passage 14. In these cases, the graft fixation memberadvantageously increases the surface area of the bone over which tensionis applied.

The recess of the washer can be sized and shaped to completely orpartially receive the button. Washers can be provided having differentsized and/or shaped recesses to accommodate different buttons. Forexample, the recessed portion 116 of washer 110 can be sized and shapedto receive the fixation buttons described in U.S. Pat. No. 6,533,802 andU.S. patent application Ser. No. 10/895,266, filed Jul. 20, 2004,published as US 2005-0038427 A1, both incorporated herein in theirentirety.

The closed-loop suture 30 can be, but is not limited to, a continuousloop made from polyester, a strand of suture tied in a loop, or a pieceof polyester closure tape (e.g. Marselene™ from Ethicon Inc.,Cincinnati, Ohio) tied in a loop.

The graft fixation member is formed from a biocompatible material suchas titanium or PEEK.

The fixation member can be used with tissue grafts other than those withbone blocks, for example, harvested tissue graft without bone blocks,and tissue grafts formed from synthetic materials or from a combinationof synthetic and natural materials.

A number of embodiments have been described. Nevertheless, it will beunderstood that various modifications may be made. For example, theaforementioned tissue graft fixation procedure may be applicable toother parts of the knee or other parts of the human body requiringtissue reconstruction. Accordingly, other embodiments are within thescope of the following claims.

1. A surgical device for tissue repair comprising: a member having firstand second opposing surfaces, the member including an intermediateportion in which the first surface has a recessed surface portion, theintermediate portion defining a hole extending from the recessed surfaceportion to the second surface, and end portions extending from theintermediate portion, wherein each end portion defines a hole, each holefor housing of suture during the tissue repair, each hole extending fromthe first surface to the second surface, wherein a gradual taper islocated along the entire distance between each end portion and theintermediate portion, the device tapered only on the second surface; andwherein at least a portion of the gradual taper is linear.
 2. Thesurgical device of claim 1, further comprising a second member sized tobe received within the recessed surface portion.
 3. The surgical deviceof claim 1, wherein the intermediate portion hole comprises an elongatedhole.
 4. A surgical device for tissue repair comprising: a first memberhaving first and second opposing surfaces, the first surface having arecessed surface portion, the first member defining a hole extendingfrom the recessed surface portion to the second surface, wherein agradual taper is located along the entire distance between end portionsof the device and an intermediate portion, and end portions extendingfrom the intermediate portion, wherein each end portion defines a holeextending from the first surface to the second surface, each hole forhousing of suture during the tissue repair, the device tapered only onthe second surface; and a second member defining a hole, wherein thesecond member is configured to be received within the recessed portionof the first member, and wherein at least a portion of the gradual taperis linear.
 5. The surgical device of claim 4, wherein the holes arepositioned to be axially aligned when the second member is receivedwithin the recessed portion.
 6. The surgical device of claim 4, whereinthe recessed portion is configured to provide a snap-fit with the secondmember.
 7. The surgical device of claim 4, wherein the recessed portionis configured to provide an interference-fit with the second member. 8.The surgical device of claim 4, further comprising a suture extendingthrough the holes.
 9. The surgical device of claim 4, wherein the firstmember defines two additional holes.
 10. The surgical device of claim 4,wherein the second member defines three additional holes.
 11. Thesurgical device of claim 4, wherein the second member hole is forhousing suture during the tissue repair.
 12. The surgical device ofclaim 2, wherein the recessed surface portion is configured to provide asnap-fit with the second member.
 13. The surgical device of claim 2,wherein the recessed surface portion is configured to provide aninterference-fit with the second member.
 14. The surgical device ofclaim 2, further comprising a suture extending through the holes. 15.The surgical device of claim 2, wherein the member defines twoadditional holes.
 16. A surgical device for tissue repair comprising: amember having first and second opposing surfaces, the member includingan intermediate portion in which the first surface has a recessedsurface portion, the intermediate portion defining a hole extending fromthe recessed surface portion to the second surface, and end portionsextending from the intermediate portion, wherein each end portiondefines a hole, each hole for housing of suture during the tissuerepair, each hole extending from the first surface to the secondsurface, wherein a gradual taper is located along the entire distancebetween each end portion and the intermediate portion, the devicetapered only on the second surface; wherein the intermediate portion ofthe second surface defines a planar surface that is substantiallyparallel to the first surface; and wherein at least a portion of thegradual taper is linear.